What are the five recovery skills?

No agency publishes an official list of "five recovery skills," and the sources that describe skills training do not agree on one number. A reasonable grouping, based on cognitive behavioral therapy (CBT) and relapse prevention material, is: spotting triggers, coping with cravings, refusing offers, solving problems, and using support.

Where this grouping comes from

The grouping draws on a NIAAA-published coping skills manual from Project MATCH, a large alcohol treatment study, along with a review of CBT for substance use disorders and a NIDA treatment guide. The MATCH manual says therapists should cover eight core topics, so five is a simplification. Other sources would sort the same material differently. The list below is the editors' choice, not a standard.

1. Spotting triggers and high-risk situations

NIDA describes self-monitoring as a CBT technique for recognizing cravings early and identifying situations that raise the risk of use. The review of CBT calls the underlying step a functional analysis: working out which people, places, moods, and events come before substance use. NIDA adds that stress cues linked to past use, such as people, places, things, and moods, are among the most common triggers for relapse.

Once triggers are known, the review notes that avoiding some of them, particularly early in recovery, can help a person reach initial abstinence before building resilience in those settings.

2. Coping with cravings and urges

The MATCH manual has a whole session on coping with cravings and urges to drink, including a daily record in which a person notes the situation, how strong the urge was, and what they did. A later review describes a "coping with craving" module that teaches people to recognize craving and use strategies such as urge surfing, monitoring, and relaxation, and that the same strategies can help tolerate any strong feeling.

3. Refusing offers

The CBT review points out that being able to turn down offers of alcohol or drugs can be a limitation, and that rehearsing socially acceptable responses in session gives people a stronger skill set to use outside it. The MATCH manual has a drink refusal session and notes that avoidance is not always possible or practical.

4. Solving problems

Problem solving is a structured way to work through a difficulty step by step. The MATCH manual placed it early in treatment on purpose, to give people in treatment and their therapists a common framework for crises that can lead to early relapse. The same review that describes the craving module says the basic steps apply to almost any problem, not only those tied to substance use.

5. Building and using support

The review lists interpersonal skills, including repairing relationship difficulties, communicating effectively, and making use of social support, as part of CBT skills building. The MATCH manual adds a practical step for lapses: examine a slip with someone rather than sweeping it aside, and call someone for help. See also mutual-help groups and supporting a family member.

What the evidence says about skills

NIDA reports that CBT was developed as a method to prevent relapse in problem drinking and later adapted for cocaine use. Evidence that skills training works is not the same as evidence for how it works. A review of CBT mechanisms notes that an early analysis found very little support for coping skills improvement as a unique mechanism for alcohol use disorder, while later studies of computerized CBT and drink refusal training did find links to better outcomes. Results are mixed.

For fuller descriptions, see relapse prevention strategies and CBT for substance use. Which skills a person works on, and in what order, is a decision for them and a qualified clinician.